Provider Demographics
NPI:1790231603
Name:TAYLOR, ASHLEY PAIGE (LMT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PAIGE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N THIRD ST
Mailing Address - Street 2:
Mailing Address - City:ELSIE
Mailing Address - State:MI
Mailing Address - Zip Code:48831-8736
Mailing Address - Country:US
Mailing Address - Phone:989-292-9576
Mailing Address - Fax:
Practice Address - Street 1:9790 E M 21
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9413
Practice Address - Country:US
Practice Address - Phone:989-292-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501002673172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist